Psyconsultant I: A DSM-IV-Based Screening Tool For Adult Psychiatric Disorders In Indian Rural Health Center

摘要

Computerized diagnostic tools have made havoc in medical science for last few decades. With the help of computerized expert tool, psychiatric illnesses can be diagnosed fast, with good accuracy rate and free from human bias. Moreover, in Indian rural health sectors, where psychiatrists are less in number, computerized screening tool could be extremely helpful for the general physicians to evaluate mental patients. The present tool, PsyConsaltant I has a long questionnaire, covering eleven broad domains of psychiatric illnesses and their sub domains. The questionnaire is set with the guidance of qualified psychiatrists to incorporate clinical experiences along with DSM-IV nosology and is put together in a computer program using logical decision tree. Finally the performance of the tol has been tested on a large set of patients and its diagnostic accuracy rate is found to be over 55% (with some variations in individual domains) and having statistical significance level 0.05. Importance of Mental Health World Health Organization (WHO) defined health “as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. Today's world has emphasized the importance of mental health, that, if disturbed, brings adverse physical, socio economic, cultural, and legal outcome. Another important reason for careful adoption of mental health could be the increasing trend of some mental illnesses, which are either primary or secondary. A common example is: premenstrual dysphoric disorders or PMDD can be assessed either from gynecology or psychiatric point of views or both [2]. Further, one's birth history [3], sex difference [4], age at onset of symptoms and age at first hospitalization [5], role of genetic [6] and biological factors [7], socio cultural and religious differences [8] etc. have made psychiatry awfully non-linear with multiple aetiopathologies. This is the enticing flavor of psychiatric research! None the less, an inherent tendency of psychiatric illnesses not to respond to the conventional treatment has added further attraction in psychiatry research. Studies have shown that several mental illnesses are gaining higher trend in the population. The hypotheses behind such increment are: i) Neuroendocrinal factors have changed its way of responding to social and psychological stress over the past few years, for example, neurohormones are now hypersensitive to most of the triggering biological, psychological and social stress factors [9], ii) Increment of other stress factors in the socio cultural purview [10 and alcoholism [11], and lastly, iii) Psychiatric patients (for e.g., schizophrenics) are in born hypersensitive to different kinds of stress, irrespective of their intensity and quality [12]. Therefore, the present society cannot thrive and mature without the proper care of mental health.Mental Health: the comparison between the Western and the Indian scenarioWestern world has realized the importance of mental health sooner to cope up with the increased stress, related to accelerating dynamism, frequent socio economic transitions and increased professional competitions to cope up with the modern lifestyle, which have immense effects on one's mental faculty. So, slowly but inevitably, they have accepted issues of mental health as one of the most important components of their daily life. In contrast to the Western view, third world's realization, especially in India is extremely dismal. It is untrue that such socio economic stress or substance abuses or other relevant triggering factors for psychiatric illnesses do not prevail here. Rather, these triggering factors are enormously present with some additional disadvantages: a) lack of social awareness, b) prevailing social taboos, c) legal and socio cultural constraints, d) poor doctor-patient interaction due to less number of psychiatrists, and e) lack of health care management infrastructure at per to the Western societies (e.g.,